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Excerpted From: Jacqueline Safstrom and Jennifer Safstrom, The Health and Legal Implications of Early Screening for Developmental Disabilities, 29 Annals of Health Law and Life Sciences 153 (Summer, 2020) (195 Footnotes) (Full Document)


SafstromandSafstromChild development is a multifaceted process and there are certain milestones to reach that are imperative for healthy, timely growth and development. Developmental monitoring, screening, and testing can aid in the identification, examination, and follow-up of a child's progress. However, there are a plethora of barriers which inhibit a child's ability to access and receive adequate, quality care. These broader factors, or social determinants of health, can lead to an underutilization of preventive health services, causing a delay in early identification and intervention for children. This can have serious, adverse repercussions, because targeting interventions among children from birth to five years old is the most impactful time to make effective changes in a child's development.

A family may experience a range of barriers to care, including limited health literacy, insufficient financial access, or fear of stigma. These issues impact access to insurance, willingness to seek care, and treatment or service options. Even when an individual can access care, other challenges, such as a lack in continuity of care or limited access to long-term services, can impede a child from accessing the support and interventions critical for their development. Without satisfactory development, a child is more likely to encounter educational challenges and legal issues. From an early age, these setbacks continue to persist and build upon one another. This lack of early detection further limits a child's ability to overcome said challenges and, in turn, results in poorer health outcomes, educational challenges, and increased legal troubles.

It is imperative to not only address and improve the lack of early developmental monitoring, but to also improve the systems aiding and contributing to these negative outcomes. Health outcomes can be improved through provider education that prioritizes awareness of child development and cultural competency. Additionally, policy changes to expand access to insurance and care, as well as professional regulation and enforcement efforts could help improve health outcomes. Similarly, educational challenges can be addressed through systemic policy reform efforts, especially those that target existing disparities, ensuring access to quality classroom opportunities and limiting bias in disciplinary practices. These reforms are essential to prevent the spillover of these effects into the criminal sphere, where individuals with a disability are overrepresented in interactions with law enforcement, convictions, and carceral populations. There additional prospective reforms-- ranging from sentencing reform to expungement efforts--that could serve to restore justice to the criminal legal system.

This paper traces the trajectory of a person through various stages of life and possible interactions with a variety of institutions.

Part II assesses the importance of childhood developmental monitoring and early intervention services, particularly as they pertain to setting a child up for success.

Part III delves deeper into the social determinants that impact a child's access to services, which in turn influence a child's health and developmental outcomes, as addressed in Part IV and educational opportunities, as explored in Part V. Finally,

Part VI highlights how a lack of opportunity at the earliest stages of life can lead to higher rates of incarceration and justice-involvement, followed by a discussion of ideas for reform.

[. . .]

There are countless health, educational, and legal consequences associated with an individual's access to, utilization of, and level of quality received in terms of health care. The results of delayed or inexistent interventions can have devastating and long-lasting negative impacts on the lives of many. By placing an emphasis on early diagnosis, intervention, and treatment for a child, there is a significant reduction in the likelihood of experiencing difficulties in an academic setting or becoming involved in the juvenile justice system.

Jacqueline Safstrom, University of Miami Miller School of Medicine, MPH, 2018; University of Miami, B.A., B.S., 2017.

Jennifer Safstrom, Georgetown University Law Center, J.D., 2018; University of Miami, B.A., 2011.

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